Running for coverage.

• Author: Biemesderfer, Susan C.
• Position: State liability for health insurance becomes apparent as health care costs eat away at budgets

State legislators scramble for health care plans as budgets crumble and the uninsured find a voice.

When Minnesota Governor Arne H. Carlson signed a new law last spring that will result in nearly 400,000 state-subsidized health insurance policies for otherwise uninsured Minnesotans, he lauded the measure as proof that his state could" deal with the gridlock" that has kept politicians from resolving the nation's health care crisis. Minnesota is one of more than two dozen states were lawmakers have been pusshed and shoved--by raw numbers and the threat of voter backlash--to make health care accessible.

According to the U.S. Census Bureau, an average 14 percent of the population nationwide--about 39 million people--have no helath insurance, and another 7 million are considered to be inadequately insured. The problems is most devastating in southern and western states, with roughly one in five people uninsured in Texas, New Mexico, California and Florida. In addition, despite outdated perceptions to the contrary, the numbers of uninsured reach beyond the poverty line; while most have below-average incomes, 26 million--two thirds--of the uninsured are employed. The health care crunch has been newly billed by economists as part of the "middle class squeeze," making it a campaign issue among the voting middle class and the "working poor," and consequently giving a political voice to uninsured Americans.

A June 1991 Gallup Poll showed that 85 percent of Americans believe the health care system must be reformed, and 51 percent believe the federal government bears the bulk of responsibility for doing so; but some experts are convinced that major reform will begin in the states. Congress has made a stab at health care reform, and although presidential hopefuls talk about it, many statehouse leaders contend that national consensus--if it is ever achieved--will have to be shaped by state initiatives.

"No governor can afford to wait for national consensus before taking action," says Catherine Dunham, a special adviser to the Robert Wood Johnson Foundation and former health policy adviser to former Massachusetts Governor Michael Dukakis. Dunham says the writing is on the wall in state budget offices: "State legislatures are forced to do everything in their power now about health care because the costs are eating away at their budgets."

California Assemblywoman Bev Hansen agrees. "Now that we finally have general agreement that the health care crisis has to be solved, we have to take some steps, implement some state-based initiatives that will start to make a difference." Hansen authored a 1992 California bill offering relief to small employers by guaranteering that insurers will offer health policies with stable premiums. "The first step for states is a very practical one. We have to make health insurance more accessible, and we have to make it more affordable. If we can make some intial progress in those respects, then we're at least headed in the right direction," she says.

Elected officials like Hansen in budget-beleaguered states like California are all too familiar with the costs of health care. In 1991, total national health care expenditures exceeded $700 billion--12.8 percent of the gross national product, and more than double the 6 percent of the GNP spent on health care in 1960. State and federal Medicaid expenditures for 1991 were about $75 billion, a staggering 20 percent surge over Medicaid figures for 1990. And according to an NCSL...